From the Guidelines
You should seek evaluation for new back pain during the second trimester of pregnancy if the pain is severe, persistent, or accompanied by concerning symptoms, as severe cases of pregnancy-related low back pain have been reported to trigger or exacerbate comorbid conditions, affecting patient well-being and functional status 1. When considering seeking evaluation, it's essential to note that low back pain and pelvic girdle pain are common during pregnancy, with low back pain occurring in up to two thirds of pregnancies 1. However, severe or unusual pain warrants immediate attention. Some key symptoms that require prompt evaluation include:
- Vaginal bleeding
- Fluid leakage
- Fever
- Burning during urination
- Pain radiating to the abdomen or legs
- Numbness, weakness, or loss of bowel or bladder control While mild back pain is common during pregnancy due to hormonal changes, weight gain, and shifting center of gravity, severe or unusual pain may indicate conditions like preterm labor, kidney infection, or other complications. In the meantime, you can try gentle stretching, proper posture, supportive shoes, heat or cold therapy, and acetaminophen (Tylenol) at recommended pregnancy doses for temporary relief, but always consult your provider before taking any medication during pregnancy. It's also important to note that the American College of Radiology recommends a fetal anatomy scan at 18 to 22 weeks’ gestation to evaluate for any congenital malformations, which may also help identify any potential causes of back pain 1.
From the Research
Evaluation for New Back Pain in Second Trimester
The provided studies do not directly address the question of when to seek evaluation for new back pain during the second trimester of pregnancy. However, they do discuss the use of pain management medications during pregnancy:
- The studies 2, 3, 4 focus on the use of paracetamol (acetaminophen) during pregnancy, its potential effects on fetal development, and the need for caution when using this medication.
- Study 5 provides a critical review of medication use and pain management in pregnancy, discussing the risks and benefits of various analgesics, including paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs).
General Guidance on Back Pain in Pregnancy
While the studies do not provide specific guidance on when to seek evaluation for new back pain, they do emphasize the importance of managing pain during pregnancy:
- Study 5 suggests that pain during pregnancy is common and its management is complex, requiring a careful assessment of risks and benefits.
- The study recommends that treatment should be tailored to the lowest therapeutic dose and shortest possible duration, and management should involve a discussion of risks and benefits and monitoring for response.
Seeking Medical Evaluation
In general, it is recommended that pregnant women seek medical evaluation if they experience:
- Severe or persistent back pain
- Sudden onset of back pain
- Back pain accompanied by other symptoms such as fever, vomiting, or bleeding
- Back pain that interferes with daily activities or sleep
It is essential to consult with a healthcare provider for personalized advice on managing back pain during pregnancy, as they can assess individual circumstances and provide guidance on the best course of treatment 5.